1770591455 NPI number — MOHAMMAD ANISUR RAHMAN M.D

Table of content: MOHAMMAD ANISUR RAHMAN M.D (NPI 1770591455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770591455 NPI number — MOHAMMAD ANISUR RAHMAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAHMAN
Provider First Name:
MOHAMMAD
Provider Middle Name:
ANISUR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770591455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1039 SPOTSWOOD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30809-5492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-574-5585
Provider Business Mailing Address Fax Number:
706-823-3960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 FREEDOM WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30904-6258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-733-0188
Provider Business Practice Location Address Fax Number:
706-823-3960
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  ME132633 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 25MA06837700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 213014 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X , with the licence number: 86643 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1677409-003 . This is a "CIGNA INSURANCE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 275060 . This is a "WELL CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2I205 . This is a "BLUE CROSS, BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C3393 . This is a "HEALTH-NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7664365 . This is a "AETNA POS AND PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2166811 . This is a "UNITED HEALTH CARE -COMME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2300691 . This is a "UNITED HEALTHCARE GOVRNME" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2577111 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2879068 . This is a "AETNA HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100232900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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